Search

Search

EPIC Coverage Available for Seniors

On January 1, 2013, the NYS Elderly Pharmaceutical Insurance Coverage (EPIC) program had many prescription benefits restored. EPIC will provide expanded coverage for those enrolled in Medicare Part D drug plans throughout the year instead of just in the Part D coverage gap. This change will result in additional savings for members to purchase needed medications.

EPIC members must be enrolled in a Medicare Part D drug plan in order to receive benefits. EPIC will provide secondary prescription coverage for Medicare Part D and EPIC covered drugs after any Medicare Part D deductible is met. Additionally, EPIC will also cover many Part D excluded drugs. EPIC co-payments will continue to be $3, $7, $15 and $20.

The EPIC Fee and Deductible Plans will be restored. Lower income members will pay an annual fee for coverage and will pay EPIC co-payments for drugs. Higher income members must meet an annual EPIC deductible before paying EPIC co-payments for drugs.

For many seniors, it is less expensive to enroll in EPIC and Medicare Part D than just Part D alone. EPIC pays the Part D drug plan premiums up to $43.22 per month in 2013 for members with incomes up to $23,000 single or $29,000 married. Higher income members are responsible for paying their Medicare Part D premiums but will receive Part D premium assistance in the form of a reduced EPIC deductible.

An NYS EPIC Regional Outreach Representative will be at the following locations to help answer questions and enroll seniors who would like to join EPIC:

It is easy to join EPIC. You must be a NYS resident, 65 years of age or older, have annual income below $35,000 single or $50,000 married, be enrolled in a Medicare Part D drug plan and not receiving full Medicaid benefits. You may apply for EPIC at any time during the year and will receive a Special Enrollment Period from Medicare allowing you to join a Part D drug plan. If you have union or retiree benefits, you should contact your benefit office to see if you are eligible to join a Part D drug plan. If you would like more information on the NYS EPIC program, please call the toll-free EPIC Helpline at 1-800-332-3742 or visit the EPIC website at www.health.ny.gov